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Case Law Database

Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ10917207

Regular

Aug 13, 2019

CARMEN ROJO vs. K & M MEAT COMPANY, STARR INDEMNITY & LIABILITY COMPANY

This case involves a dispute over the necessity of an additional Qualified Medical Evaluator (QME) panel in orthopedic surgery. The Applicant sought reconsideration of an administrative law judge's (ALJ) order for a new orthopedic QME panel, arguing it was an abuse of discretion and prejudicial. The Appeals Board granted reconsideration, finding the original QME's referral for an orthopedic evaluation was for treatment, not a recommendation for a new medical-legal evaluation. Consequently, the Board amended the ALJ's findings, holding there was no good cause for an additional orthopedic QME panel and denying the defendant's request.

QME panelorthopedic surgeryreconsiderationremovalFindings & Orderchiropractic QMEmedical-legal evaluationgood causesupplemental pleadingmedical dispute

References

Case No. ADJ9975590; ADJ9976116

Regular

Feb 25, 2016

Ana Nieto vs. Avitus, Inc., American Zurich Insurance Company

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for reconsideration, finding the appealed order was interlocutory and not subject to reconsideration. The WCAB treated the petition as one for removal and denied it, as the defendant failed to demonstrate substantial prejudice or irreparable harm. The defendant's contention that their trial exhibits and an orthopedic QME panel were erroneously stricken was rejected, as was their claim that the orthopedic QME panel was improperly denied. The defendant failed to provide sufficient evidence to support their request for an orthopedic QME panel over a chiropractic one.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalJoint Findings of Fact & OrdersQualified Medical Evaluator (QME)Orthopedic Surgery QMEChiropractic QMETrial ExhibitsAdministrative Law Judge (WCJ)Labor Code § 4062.2

References

Case No. ADJ11913752

Regular

Nov 19, 2019

LAURA DOW vs. UCSF, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES

This case concerns a dispute over the proper procedure for requesting a Qualified Medical Evaluator (QME) panel after a workers' compensation claim was denied. The Workers' Compensation Appeals Board (WCAB) granted removal, reversing a WCJ's decision. The WCAB found that the defendant's request for an orthopedic surgery QME panel was valid, initiated after the denial notice and statutory waiting period. They also determined that orthopedic surgery was an appropriate specialty, overriding the WCJ's order for a pain medicine panel. The parties are now directed to proceed with the orthopedic surgery QME panel.

QME panelPetition for RemovalOpinion and OrderFindings and OrdersMedical UnitPain MedicineOrthopedic SurgeryDenial NoticeQualified Medical EvaluatorLabor Code Section 4060

References

Case No. ADJ8491619 ADJ9586677

Regular

May 17, 2019

Edward GAA vs. Intercare Holdings Insurance, The Hartford

The Workers' Compensation Appeals Board granted applicant's petition for removal, overturning a prior order that denied a rheumatological evaluation. While dismissing the petition for reconsideration, the Board found good cause for an additional QME panel in rheumatology, acknowledging the orthopedic QME's limited expertise in this specialty. The applicant must still attend a re-evaluation with the orthopedic QME, who must review a job analysis.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalQualified Medical Evaluator (QME)Rheumatological evaluationOrthopedic QMECumulative traumaIndustrial injuryMedical-legal issuesBias

References

Case No. ADJ8182717, ADJ8253375, ADJ8253377

Regular

May 18, 2018

VICTOR MCGILL vs. COUNTY OF FRESNO

This case involves a workers' compensation applicant seeking reconsideration of a judge's decision invalidating a chiropractic QME panel. The Appeals Board dismissed the petition for reconsideration as the judge's order was not a final determination. However, the Board granted removal, finding that an orthopedic QME panel was necessary for the applicant's foot and Achilles tendon injuries, as chiropractic was not the appropriate specialty. The decision rescinds the judge's order and returns the matter for further proceedings to obtain an additional orthopedic QME evaluation.

WCABRemovalReconsiderationQMEMedical DirectorChiropracticOrthopedic SurgeryPanelFindings of Fact and OrderMedical Unit

References

Case No. ADJ11861160

Regular

Oct 25, 2019

ADRIANA MARTINEZ vs. AVITUS, AMERICAN ZURICH INSURANCE COMPANY, GALLAGHER BASSETT SERVICES

This case involves a dispute over the selection of Qualified Medical Evaluator (QME) panels for an applicant with claimed injuries to multiple body parts. The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for removal, rescinded the prior decision, and found that the applicant's chiropractic QME panel request was proper while the defendant's orthopedic surgery panel request was improper. The WCAB determined that chiropractic medicine is the appropriate specialty and struck the orthopedic surgery panel, ordering the parties to proceed with the chiropractic QME. The WCAB clarified that while chiropractors cannot perform surgery or prescribe medication, they are qualified to evaluate injuries within their scope of practice.

QME panel disputeremoval petitionchiropractic specialtyorthopedic surgery specialtyLabor Code 4062.2Medical Directoradministrative law judgeWorkers' Compensation Appeals Boardproper panel selectioninvalid panel request

References

Case No. LBO 0383944

Regular

Apr 07, 2008

GABRIEL RODRIGUEZ vs. GARDENA NISSAN, SENTRY CLAIMS SERVICE

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for reconsideration, finding the prior order was procedural and not final. However, the WCAB granted removal, rescinded the prior order, and authorized the defendant to obtain a second orthopedic QME. This decision was based on the necessity of obtaining crucial medical evidence regarding the applicant's orthopedic condition, which the current internal medicine QME could not address, thus preventing a just adjudication.

Workers' Compensation Appeals BoardPetition for ReconsiderationGranting RemovalDecision After RemovalSpecialty Physician Panel QMEOrthopedicsMedical UnitLabor Code section 4062.2Industrial InjuryLeft Shoulder

References

Case No. ADJ9099536

Regular

Sep 09, 2014

MARIA SOTO vs. CCC HOSPITALITY PISMO, LLC dba SEACREST OCEANFRONT HOTEL, STAR INSURANCE COMPANY

In this case, the defendant hospital sought removal after the WCJ ordered a chiropractic QME panel, arguing chiropractors were unqualified for the applicant's knee injury. The defendant had initially requested an orthopedic surgeon QME, but their request was rejected by the Medical Unit as incomplete. The Appeals Board found the defendant's initial request substantially complied with regulations and was improperly rejected. Therefore, the Board granted removal, rescinded the WCJ's order, and directed the Medical Unit to issue a panel of orthopedic surgery QMEs.

Petition for RemovalPQMEMedical UnitChiropractic QMEOrthopedic Surgery QMERequest for QME PanelAdministrative Director Rule 30(b)Labor Code section 4062.2Messele v. Pitco FoodsInc.

References

Case No. ADJ9317724

Regular

Jul 23, 2015

JUAN TORRES vs. LINEAGE LOGISTICS COLD STORAGE, TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the applicant's Petition for Removal. The applicant sought to overturn a Minute Order compelling an orthopedic QME evaluation, arguing the existing orthopedic panel was improperly obtained and preferred a treating doctor. The Board adopted the WCJ's recommendation, finding no substantial prejudice or irreparable harm, as removal is an extraordinary remedy not warranted here. The applicant's preference for a treating doctor did not override the WCJ's order for a QME evaluation requested to clarify a prior medical opinion regarding potential knee surgery.

Petition for RemovalQualified Medical EvaluatorOrthopedic QMEChiropractic QMEKnee SurgeryIndependent Medical OpinionMPNMedical Treatment AuthorizationPrimary Treating PhysicianReconsideration

References

Case No. ADJ11629744

Regular

Apr 24, 2023

ROCHELLE BOYD vs. VISSER, NATIONAL INTERSTATE RICHFIELD

The applicant sought reconsideration after the WCJ denied injury claims to the brain, internal system, psyche, and sexual dysfunction, as well as the issuance of additional QME panels. The Appeals Board granted reconsideration, finding good cause existed for additional QME panels in internal medicine and psychiatry. The original findings of fact were rescinded, and the issue of further QME panels in urology and neurology was deferred. The Board concluded that additional QME evaluations were necessary for a full adjudication of the claimed injuries outside of the admitted orthopedic injuries.

Workers' Compensation Appeals BoardPetition for ReconsiderationQualified Medical EvaluatorQME panelsinternal medicinepsychiatryneurologyurologysexual dysfunctionpsyche

References

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Updated Daily

Case Law Database

Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ10917207

Regular

Aug 13, 2019

CARMEN ROJO vs. K & M MEAT COMPANY, STARR INDEMNITY & LIABILITY COMPANY

QME panelorthopedic surgeryreconsiderationremovalFindings & Orderchiropractic QMEmedical-legal evaluationgood causesupplemental pleadingmedical dispute

References

Case No. ADJ9975590; ADJ9976116

Regular

Feb 25, 2016

Ana Nieto vs. Avitus, Inc., American Zurich Insurance Company

References

Case No. ADJ11913752

Regular

Nov 19, 2019

LAURA DOW vs. UCSF, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES

QME panelPetition for RemovalOpinion and OrderFindings and OrdersMedical UnitPain MedicineOrthopedic SurgeryDenial NoticeQualified Medical EvaluatorLabor Code Section 4060

References

Case No. ADJ8491619 ADJ9586677

Regular

May 17, 2019

Edward GAA vs. Intercare Holdings Insurance, The Hartford

References

Case No. ADJ8182717, ADJ8253375, ADJ8253377

Regular

May 18, 2018

VICTOR MCGILL vs. COUNTY OF FRESNO

WCABRemovalReconsiderationQMEMedical DirectorChiropracticOrthopedic SurgeryPanelFindings of Fact and OrderMedical Unit

References

Case No. ADJ11861160

Regular

Oct 25, 2019

ADRIANA MARTINEZ vs. AVITUS, AMERICAN ZURICH INSURANCE COMPANY, GALLAGHER BASSETT SERVICES

References

Case No. LBO 0383944

Regular

Apr 07, 2008

GABRIEL RODRIGUEZ vs. GARDENA NISSAN, SENTRY CLAIMS SERVICE

References

Case No. ADJ9099536

Regular

Sep 09, 2014

MARIA SOTO vs. CCC HOSPITALITY PISMO, LLC dba SEACREST OCEANFRONT HOTEL, STAR INSURANCE COMPANY

Petition for RemovalPQMEMedical UnitChiropractic QMEOrthopedic Surgery QMERequest for QME PanelAdministrative Director Rule 30(b)Labor Code section 4062.2Messele v. Pitco FoodsInc.

References

Case No. ADJ9317724

Regular

Jul 23, 2015

JUAN TORRES vs. LINEAGE LOGISTICS COLD STORAGE, TRAVELERS INSURANCE COMPANY

Petition for RemovalQualified Medical EvaluatorOrthopedic QMEChiropractic QMEKnee SurgeryIndependent Medical OpinionMPNMedical Treatment AuthorizationPrimary Treating PhysicianReconsideration

References

Case No. ADJ11629744

Regular

Apr 24, 2023

ROCHELLE BOYD vs. VISSER, NATIONAL INTERSTATE RICHFIELD

Workers' Compensation Appeals BoardPetition for ReconsiderationQualified Medical EvaluatorQME panelsinternal medicinepsychiatryneurologyurologysexual dysfunctionpsyche

References

Showing 1-10 of 1,178 results

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